What the Joint Commission’s Guidance on Texting Means for Physicians

PerfectServe's Terry Edwards explains why the new guidelines for texting will improve care team efficiency - and make the doctor's life easier.

June 02, 2016 - The Joint Commission recently issued new guidance to give physicians and other independent practitioners the ability to not just communicate via text, but to actually use secure texting platforms to deliver orders. This is a major change from the commission’s historic policy, which severely limited the role that texting could play in care delivery, and recognizes the shift that’s happening with technology’s role in healthcare.

The limit on texting has been a major topic of debate – and source of frustration – among physicians, nurses and other critical members of the care team. Texting is such a routine form of communication for most people in their daily lives (most of us spend about 25 minutes every day texting) that it becomes difficult to adjust strategies at work. However, the sensitivities of healthcare require these changes not be made without proper consideration and standards.

Security concerns have been a barrier to opening up secure texting to more physicians. While recent data hacks, ransomware attacks and other HIPAA violations have shown us that security risks are increasing, many secure communication platforms have beefed up security protocols and increased the protection of personal health information. The new policy sets specific standards on the security protocols that secure texting solutions must have in place, such as encrypted messaging and message retention times, before they’re authorized to be used for texting orders.

The new policy also addresses patient safety concerns. It’s important that any communication method - texting included - ensures that the right person gets the right message at the right time, to provide timely care. The Joint Commission’s new policy helps ensure this through the requirement of secure sign-on processes to verify the identity of the initiator, as well as delivery and read receipts to make sure the message is received by the right person.

The biggest impact of the ruling will be on the efficiency of the care team. Texting helps avoid “phone tag,” to which many clinicians have become accustomed. For example, when new test results are available, in certain circumstances a nurse must contact the ordering or covering physician to share those results, often via phone. After the nurse reads the results, the physician may respond with a verbal order – medication, therapy or a consult. The nurse would write this order down or enter it into the EHR and then verbally read the order back to the physician to confirm the order is correct. This type of back and forth can be time consuming especially in a busy hospital environment.

Secure texting would be more efficient for everyone involved in this situation.

This increase in efficiency will be key. Clinicians are strapped for time – the average patient caseload of a primary care physician is 2,300 patients, with about 94 patient encounters per week, according to a noted Annals of Family Medicine article. Inefficient communication is a major drain on their time, taking them away from direct patient care. Further compounding the problem, 52 percent of clinicians admit they don’t always know the correct care team member to contact, according to a survey of nearly 1,000 health system professionals conducted online by Harris Poll and released by PerfectServe.

It’s not a perfect situation. Physicians may be worried about giving everyone within a hospital – including folks with whom they don’t typically work – the ability to text them directly. Not only does this create the challenge of too many communications, but it could also spur liability concerns. In time, organizations will determine best practices and codes of conduct.

While this recent decision is a big step in the right direction, there’s still much more that needs to be done to address the challenge of secure communications. This move gives organizations the incentive to get the right systems in place for effective, secure communications.

Texting alone is incomplete and cannot be the be-all and end-all. While texting is appropriate for some types of communication (such as brief updates or a short exchange), longer or more complex conversations or updates require secure ways for the extended care team to communicate through a combination of phone, e-mail and other communication modalities. In fact, of the health professionals surveyed, 81 percent reported dissatisfaction due to a lack of unified communications.

This new, more sophisticated approach to secure communications should be part of a comprehensive care team collaboration strategy. It is especially important as we evolve to value-based models with a care team approach, where multiple clinicians from various departments and facilities must work together around one patient. It needs to be about the right message, the right person and the right channel.

Terry Edwards is the founder, president and CEO of PerfectServe. Prior to starting PerfectServe, he served as vice president of sales for Voice-Tel and co-founded the Milepost Corporation, a marketing communications firm that served the automotive and manufacturing industries. Before launching into entrepreneurial ventures, he studied music at Bowling Green University and religion at Lourdes College.